by the author of "The Paramedic Heretic" & "America's Dumbest Doctors"

Monthly Archives: May 2013

It was exactly two years ago that QuantiaMD conducted a national survey, finding 66% of U.S. doctors witness other physicians disrupting patient care, or damaging their professional relationships, while at work. And 10% reported that they see bratty kid behavior everyday.

“Our profession is plagued by doctors acting in a way that is disrespectful, unprofessional and toxic to the workplace.”

Doctor Silbaugh hopes the survey will shine a light on “the shadowy, dark corners of our profession” where doctors act in arrogant, demeaning and even physically violent ways. Silbaugh likened it to pilots “fighting in the cockpit.”

A 14-page white paper put out by the American College of Physician Executives noted:

A doctor who was being monitored because of a long history of rudeness again yelled at a nurse, resulting in “a significant medication error and harm to a child.”

A prominent surgeon’s habit of degrading comments aimed at nurses and support staff eventually resulted in “shoving and pushing…in the OR.”

A male doctor created “an intolerable work environment for a female physician” through “condescending, bullying” and refusing to acknowledge her supervisory role.

75% of the respondents said they’re worried about disruptive behavior by their fellow MDs. Nearly every doctor who responded stated the shenanigans negatively affected patient care.

25% of doctor-respondents admitted they themselves had been guilty of disruptive behavior at one time or another. The most common reasons, they said, were heavy workload and bad habits they learned in medical school.

50% of the doctors surveyed say they’ve witnessed other physicians yelling, insulting, refusing to cooperate with medical staff, and refusing to follow established rules.

Also common – and very disturbing – are doctors throwing things; retaliating; working drunk or under the influence of drugs and assaulting co-workers.

For more detail on cases of doctors misbehaving, see this Google map of cases brought before medical boards across the country. Investigative reporter William Heisel spent the better part of a year sifting through records for a series he called “Doctors Behaving Badly” on the Reporting on Health website.

SUFFERING FROM A TOOTHACHE, a woman in South Carolina headed to her local emergency room a few months ago. The doctor there responded by administering Dilaudid, a powerful narcotic typically reserved for cancer-related pain. Why, his nurse queried, was he killing a flea with a sledgehammer? Afraid of malpractice? No, the doc replied. “Press Ganey. My scores last month were low.”

Press who? The little-known company has become a hated target of hospital physicians, outstripping even trial lawyers. Utter its name and you’ll likely unleash a cloud of four-letter words. Press Ganey is the nation’s leading provider of patient satisfaction surveys, the Yelp equivalent for hospitals and doctors.

Over the past decade the government has fully embraced the “patient is always right” model–these surveys focus on areas like waiting times, pain management and communication skills–betting that increased customer satisfaction will improve the quality of care and reduce costs. There’s some evidence they have. An ObamaCare initiative adds extra teeth, to the tune of $850 million, reducing Medicare reimbursement fees for hospitals with less-than-stellar scores.

Accordingly, hospitals kowtow to Press Ganey. In November nearly 2,000 administrators spent $1,100 or more each to attend Press Ganey’s glittery client conference–a closed-to-the-public affair in Washington, D.C., with keynotes by Jeb Bush and astronaut Mark Kelly and his wife, former congresswoman Gabby Giffords. Press Ganey is helping hospitals fulfill their mandated obligation. Some have taken an extra step, tying physicians’ compensation to their ratings.

That may sound like a good thing. Why shouldn’t you grade the quality of your medical care, the way that you pass judgments on other services, whether hotel stays via TripAdvisor or contractors via Angie’s List?

The short reason: The current system might just kill you. Many doctors, in order to get high ratings (and a higher salary), overprescribe and overtest, just to “satisfy” patients, who probably aren’t qualified to judge their care. And there’s a financial cost, as flawed survey methods and the decisions they induce, produce billions more in waste. It’s a case of good intentions gone badly awry–and it’s only getting worse.

But what exactly are Press Ganey and its two main rivals, the Gallup polling company and the publicly traded National Research Corp., measuring? Customers know what they want when they review spaghetti carbonara for Zagat. But giving patients exactly what they want, versus what the doctor thinks is right, can be very bad medicine. Last February researchers at UC Davis, using data from nearly 52,000 adults, found that the most satisfied patients spent the most on health care and prescription drugs. They were 12% more likely to be admitted to the hospital. Strikingly, they were also the ones more likely to die.

Why? The UC Davis authors posit that the most satisfied patients have a higher mortality rate because they receive more discretionary services–interventions that carry a risk of adverse effects. Even routine screenings for diseases like prostate cancer can lead to unnecessary drugs and operations with allergic reactions and surgical complications that leave patients worse off.

“Numerous studies have found that patients are consistently highly satisfied with one of the most common downsides of medical care–false-positive test results and the downstream events that follow,” wrote Dr. Brenda Sirovich of the VA Outcomes Group in White River Junction, Vt., commenting on the UC Davis study. “Almost any unnecessary or discretionary test has a good chance of detecting an abnormality.” Such testing “is a double-edged sword,” explains Dr. H. Gilbert Welch in his 2011 book, Overdiagnosed, often leading to “the detection of abnormalities that are not destined to ever bother us.”

Our health care system already suffers from a “more is always better” fallacy. “Practicing physicians have learned–from reimbursement systems, the medical liability environment and clinical performance scorekeepers–that they will be rewarded for excess and penalized if they risk not doing enough,” says Sirovich. An overreliance on patient surveys, she says, only inflames the problem of overtreatment.

As hospitals increasingly tie physicians’ compensation to patient wishes, doctors are pushed even further down the dangerous path of overtreatment. Nearly two-thirds of all physicians now have annual incentive plans, according to the Hay Group, a Philadelphia-based management consultancy that surveyed 182 health care groups. Of those, 66% rely on patient satisfaction to measure physician performance; that number has increased 23% over the past two years.

THE MATH IS NOW SIMPLE FOR DOCTORS: More tests and stronger drugs equal more satisfied patients, and more satisfied patients equal more pay. The biggest loser: the patient, who may not receive appropriate care.

“By creating a monetary incentive to increase patient satisfaction, the government is not only increasing expenses but promoting a metric that significantly increases death rates,” says William P. Sullivan, an emergency room doctor in Spring Valley, Illinois.

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Our Observations:

Doctor Andrea Sharp made the following comments:

“Suggesting MD’s are ordering excessive tests solely based on desires for increased compensation is ludicrous.”

Dr. Sharp, it is our sincere hope that the reason you say this is simply because you are too busy in your daily work to pay much attention to the reality outside of your normal purview.

It is our hope you are not deliberately choosing to turn a blind eye to the jaw-dropping amount of fraud perpetrated by physicians nationwide.

You may well not be aware that almost exactly 10 physicians are found guilty of felony-level behavior every single court calendar day of the year – just over 200 doctor convictions EVERY month.

As an emergency professional who has treated more than 20,000 patients myself, I can promise you I ignored the crimes that I witnessed by MDs for years. I found it extremely difficult to open my mouth and actually admit that the status quo in medicine is exactly what has brought the roof down on the excellent practitioners among us.

Tell me this: if you were the CEO of an insurance payor organization, for example. How generous would you be toward a profession that performs well over 100,000 unnecessary (and occasionally lethal) surgical procedures per month?

Sadly, we as a society are way, way past the day when the lay-public – or law enforcement, for that matter – believed that physicians in the aggregate are ethical enough to police themselves.

The Nat’l Practitioner Data Bank can give you 100,000 reasons why that just isn’t true.

“There should be some leniency and trust that a person who chooses a profession “to help people”, sacrifices at minimum 12years of education, and commits to life-long learning and service will do the best with the education and skills they have worked hard to develop.”

Until the day comes when ethical & competent physicians stop turning a blind eye to their peers who should be behind bars, you ought not be surprised that others, outside the profession, feel the imperative to change the seriously ugly status quo.

11,000 doctor convictions over the last decade is not a small matter. And the impact of those arrests has dramatically changed the playing field upon which physicians of excellence – presumably like yourself – find themselves.

“Society has unrealistic expectations regarding their health care and what is necessary.”

You are absolutely right. But with 1,000 TV commercials each day yammering about the miracles of treatments from ED drugs to restless leg syndrome, why on earth would you expect otherwise?

A student-physician in Canada was found guilty last week in a sexual assault case that occurred at Winnipeg Children’s Hospital four years ago.

Doctor Walid Abdelhamid, now 35, is scheduled to be sentenced in July.

During the trial, the court heard testimony from an 18-year-old male who described in detail how he was sexually assaulted as he lay paralyzed in the hospital. He described being attacked twice in the same day, while bedridden with a broken back as the result of a motorcross collision.

Healthcare is a fertile playground for the deranged

According to court records, Abdelhamid was never assigned as the physician of record for the boy, who was 15 at the time. He was actually doing advanced medical training elsewhere in the hospital, on a student visa, on the day of the incident.

During the reading of the verdict, the judge stated she found the testimony by the victim was credible.

Abdelhamid, who had been arrested in 2009, was the subject of an interpol manhunt after fleeing to Greece following his initial release on bail. He was subsequently caught by police in Crete and extradicted to Canada.

Doctor Michael Durante: “You can make $5,000 a week selling this stuff on the streets.”

In the city of Montclair a physician has been found guilty of writing thousands of illegal prescriptions.

Doctor Michael Durante, an internal medicine specialist, was convicted in federal court of selling the synthetic narcotic oxycodone, having dispersed illegal prescriptions for as many as 70,000 pills.

Durante, age 58, was convicted of 16 of the 17 charges originally filed.

According to John McCabe, DEA Special Agent of the New Jersey Division, Durante was arrested in March 2011 as one of 12 men in a drug distribution conspiracy.

During the investigation, Durante was secretly recorded instructing a DEA undercover agent to be careful, and take the prescriptions to several different pharmacies to avoid suspicion.

In court, the jury also heard the doctor openly discussing the resale value of the drugs on the street – $1,000 to $1,200 per bottle – and that based on the number of prescriptions Durante was providing, the buyers could expect to make up to $5,000 per week.

Durante could receive a 20-year prison sentence, as well as a $250,000 fine for each of the 16 felonies.

In San Diego Federal Court Doctor Eduardo Arellano Felix pleaded guilty yesterday to charges that will send him to federal prison for 15 years.

The 56-year-old Felix is the last male of his immediate drug-running family to be either caught or killed. He admitted in court that he had been a key player in the Arellano Felix cartel that shipped hundreds of millions of dollars in laundered money from the U.S. to Mexico.

Think all doctors have your best interest in mind?

One of Felix’s brothers who founded the Tijuana-based cartel was shot and killed by Mexican police. Two others are in American prisons.

Felix was extradited from Mexico last summer and held in federal custody in San Diego. He had been captured in a 2008 shootout at his compound in Tijuana while keeping his 11-year-old daughter nearby.

Felix’s 54-year-old sister, Enedina Arellano Félix de Toledo, is suspected to be the leader of the powerful Tijuana Cartel, and – according to the U.S. Drug Enforcement Administration – may well be the only female leader of a major drug organization in the world.

This morning on WABC-7 TV in New York, Doctor Sapna Parikh, a medical contributor to the station, filed the following report:

Dr Sapna Parikh

_________________________________________________________________

Common things we all do everyday could cause us to have a stroke! Things like yoga and even blow drying your hair.

This type of stroke often happens in young, healthy people, but most people have never heard of it.

On a Friday last September, Shawn Crawford was enjoying the amusement park rides. Then he had a headache all weekend, and by Monday was seeing flashing lights.

“Very suddenly I lost 90% of my vision and everything went a very milky white,” Crawford said.

36 years old and he was having a stroke. Shawn had a dissection of his left carotid artery. It’s a tear of the inner lining of the blood vessel.

That injury causes a blood clot and blood flow to the brain stops. Dr. Carolyn Brockington is director of the stroke center at St. Luke’s Roosevelt Hospital. She says the roller coaster may be to blame.

“It’s really just that you moved your head or neck in the wrong way. It’s usually young healthy people,” Dr. Brockington said.

It happened to 31-year old Lauren Teo last month. She was blow drying her hair.

“When I flipped my head up I felt this snap but I didn’t think anything of it,” Teo said.

An hour later, she was dizzy and slurring her words.

There are 4 major arteries to the brain – the 2 carotids in front, 2 vertebral arteries in the back. If any one of them is injured, you can end up with a stroke.

Dr. Brockington says she sees 4 or 5 patients a month.

“One person was running in the park and she had a dissection because she turned her head in the wrong way. Another person was doing yoga and had a dissection,” Brockington said.

Lauren has almost fully recovered but still has trouble finding words. Shawn has no peripheral vision on the right and still struggles with reading. The message is not to stop riding roller coasters or drying your hair. It is about knowing the warning signs

“If someone develops with neck pain, but in association with sudden weakness or the face is dropping or speaking that maybe those things are linked and it’s time to go the emergency room right away,” she said.

Do you actually possess the gold-plated, unmitigated gall, to warn the public of the “risks” of blow-dryers, or performing Yoga, when health care gone wrong kills 450+ citizens EVERY DAY?

From one medical professional to another, I strongly suggest you make a serious adjustment to your logic compass.

The reality is this: NOTHING injures & kills more people in the U.S. than errant health care. And as long as 2,500 wayward doctors are convicted each year, yammering about the dangers of hair dryers is asinine and dishonest.

Are you really interested in guiding the public toward safer daily practices? If so, why not warn them of the 200+ citizens who die each day as a result of hospital-acquired infections?

Why not educate yourself about the thousands of people who die each year for no better reason than they were subjected to one of the estimated 1,500,000 unnecessary surgical procedures?

Your report is a shameful dodging of the REAL dangers to the citizenry.

In Toronto Canada, the former medical health officer in an area known as the York Region, dropped his head and gasped as he was found guilty yesterday of indecent sexual assaults on four young boys, on charges dating back to the 1950s.

Dr John O. Slingerland

The court found that the allegations against Doctor John O. Slingerland, age 90, were credible, and that the doctor’s defense arguments were not believable. The charges were made by four men who testified they were assaulted by him when he was their family doctor.

Slingerland, who lived and treated patients in the small community of Mount Albert for about 12 years beginning in 1960, was also a United Church elder and Cub Scout leader.

The indictment occurred in 2010 and he pleaded not guilty to indecent assault of four boys, who ranged in ages from five to 13.

During the trial, Slingerland admitted he performed medical examinations on children in the basement of his church, as opposed to his clinic, but said the exams were part of the merit badge program of the Cub Scouts. The victims described in detail incidences of masturbation performed on them by the doctor.

Assistant Crown Attorney Jennifer Gleitman asked the doctor if he would be surprised that no Cub Scout badges are given for medical examinations.

Slingerland bristled. “You would be wrong. There’s not nowadays, but there was at that time.”

Slingerland testified that he never touched any of the children in a sexual manner.

In the end, in the Newmarket district court, Justice Anne Mullins, who spent more than an hour reading the non-jury verdict said this:

“I do not accept the evidence of Owen Slingerland.”

The elderly physician leaned on his cane while listening to the verdict on a special hearing device provided by the court.

Slingerland, who retired in 1988, was not being held in custody during the trial and who is free on bail today, will return to court for Sentencing July 8.